I, [Patient Name], provide my informed and voluntary consent to receive AYUSH services through the MyAyushClinic platform. I understand and acknowledge:
1. Nature of Services: I will receive AYUSH consultation (Ayurveda, Homeopathy, Siddha, Unani, or Yoga & Naturopathy) via video, audio, or chat.
2. Practitioner Qualifications: My Practitioner is an independent, registration-verified AYUSH professional (NCISM/CCIM / State AYUSH Board). MyAyushClinic verifies registration to the extent reasonably possible but does not control clinical judgment.
3. Limitations: teleconsultation may not suit all conditions; connectivity disruptions may occur; in-person examination and in-person Nadi (pulse) assessment are not possible; non-verbal cues may be limited; confidentiality depends on a secure connection and privacy at both ends.
4. Risks: as with any intervention, outcomes may vary and active participation is essential.
5. Emergency: the Platform is not an emergency service. In a medical emergency I will contact 112 or a hospital immediately.
6. Confidentiality: my consultations are encrypted; my Practitioner is bound by professional ethics and the Platform NDA. Exceptions: imminent risk of harm, suspected child abuse, court orders, and mandatory reporting.
7. Records: consultation notes are maintained by my Practitioner on the Platform; I may request access subject to verification and legal limits.
8. Fees · 9. Withdrawal · 10. Data: the fee is shown before booking and I authorise payment; I may discontinue or switch Practitioner at any time; my data is processed per the Privacy Policy and DPDPA 2023.
☐ I have read and understood this Informed Consent. ☐ My questions have been answered. ☐ I voluntarily consent to receive AYUSH teleconsultation via MyAyushClinic.
Patient Name: · Date: · Digital Consent (Checkbox): ☐
— DRAFT V1.0 · PENDING LEGAL REVIEW —